ÍøÍÑ¿½¹þ½ñ APPLICATION FORM




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³Ø²ñ²ñ°÷»á̾(Name):
½ê°(Affiliation):
ÅŻҥ᡼¥ë¥¢¥É¥ì¥¹(e-mail address):
½»½ê(address):
ÅÅÏÃ(Phone):
¥Õ¥¡¥Ã¥¯¥¹(Fax):
·ÈÂÓÅÅÏÃÈÖ¹æ
(movable phone):
¡¡¡¡²ñ´üÃæ¤Î»ÈÍÑ(use during JPS meeting): ²Äǽ(yes) ÉÔ²Äǽ(no)
ÍøÍÑÎÁ¤ÎÀÁµáÀè¡Ê¾åµ­¤È°Û¤Ê¤ë»þ¡Ë
(another address for payment):
¡¡¡¡½»½ê2(address2)
¡¡¡¡»á̾2(name2)
¥Ñ¡¼¥È¥Ê¡¼¤¬Æ±¤¸³Ø²ñ¤Ë»²²Ã¤¹¤ë¾ì¹ç
accompanied person(JPS member)
¡¡¡¡³Ø²ñ²ñ°÷»á̾(Name):
¡¡¡¡½ê°(Affiliation):
¡¡¡¡ÅŻҥ᡼¥ë¥¢¥É¥ì¥¹(e-mail address):
¡¡¡¡²ñ´üÃæ¤Î·ÈÂÓÅÅÏÃÈÖ¹æ
(movable phone):
¸æÍøÍѤˤʤ뤪»Ò¤µ¤Þ¤Î¿Í¿ô(Number of children):
¸æÍøÍÑͽÄêÆü(date): 17(Mon) 18(Tue) 19(Wed) 20(Thr)

¸æÍøÍÑ»þ´Ö(time):ex. 8:30~18:30
17(Mon)~
18(Tue)~
19(Wed)~
20(Tur)~


¤ª»Ò¤µ¤Þ¤Î¤ªÌ¾Á°(name of child 1):
À¸Ç¯·îÆü(birthday: yy/mm/dd:ex.98/03/31):
À­ÊÌ:ÃË»Ò boy ½÷»Ò girl
¤ª»Ò¤µ¤Þ¤Î°¦¾Î(nickname of child 1):


¤ª»Ò¤µ¤Þ¤Î¤ªÌ¾Á°2(name of child 2):
À¸Ç¯·îÆü(birthday: yy/mm/dd:ex.98/03/31):
À­ÊÌ:ÃË»Ò ½÷»Ò
¤ª»Ò¤µ¤Þ¤Î°¦¾Î(nickname of child 2):


¤ª»Ò¤µ¤Þ¤Î¤ªÌ¾Á°3 (name of child 3):
À¸Ç¯·îÆü(birthday: yy/mm/dd:ex.98/03/31):
À­ÊÌ:ÃË»Ò ½÷»Ò
¤ª»Ò¤µ¤Þ¤Î°¦¾Î(nickname of child 3):


¤ª»Ò¤µ¤Þ¤Î¤ªÌ¾Á°4 (name of child 4):
À¸Ç¯·îÆü(birthday: yy/mm/dd:ex.98/03/31):
À­ÊÌ:ÃË»Ò ½÷»Ò
¤ª»Ò¤µ¤Þ¤Î°¦¾Î(nickname of child 2):


optiion:

¤½¤Î¾¥³¥á¥ó¥È(any comments, please):